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41. Data Collection Form | Digital Healthcare Research
    digital.ahrq.gov/document-type/data-collection-form
    January 01, 2023 - Data Collection Form ADE Incident Identification Form Description … This form identifies an adverse drug event using data reported by a clinician. … Description This form is used to classify ADEs and near misses. … Description This is a chart review form for an adverse drug event (ADE) study. … Description This is a near miss classification form for an adverse drug event study.

42. ADE Incident Identification Form | Digital Healthcare Research
    digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/ade-incident-identification
    January 01, 2023 - ADE Incident Identification Form Description This form identifies an adverse … Document Type Data Collection Form Document Source Statewide Implementation of Electronic … Health Records PDF ADE Incident Identification Form

43. 4 Tk2 T1-Medical Care Referral Form (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK2_T1-Medical_Care_Referral_Form.pdf
    May 01, 2014 - Excellence in Health Care www.ahrq.gov Agency for Healthcare Research and Quality MEDICAL CARE REFERRAL FORM … Advanced directive/ MOST Form: Yes No ? DNR Yes No ? No Antibiotics Yes No ?

44. Combined Signup Form | CDS Connect
    cds.ahrq.gov/cdsconnect/signup
    Search All AHRQ Sites Careers Contact Us Español FAQs Email Updates

45. Release Form for AHRQ To Use Copyrighted Material (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/publications/pubcomguide/Appendix1-A-PermissionForms.pdf
    April 01, 2024 - for Video Shoots Location Release Form for Video Shoots Instructions This Location Release Form … Do not use this form to receive materials from an archival site, such as iStock. … Talent Release Form Instructions This Talent Release Form must be completed by nongovernment … Completed release forms are recommended for people whose video appearances are possible but uncertain … Talent Release Form.

46. Release Form for AHRQ To Use Copyrighted Material (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/publications/pubcomguide/Copyright-fillable-form.pdf
    April 01, 2024 - Release Form for AHRQ To Use Copyrighted Material Instructions This form must be completed by Contractors … Release Form for AHRQ To Use Copyrighted Material The undersigned hereby grants permission to the Agency … lines as needed by selecting Return]: E-signature of copyright holder (type name): Date: Release Form

47. Telewound Care Network PATIENT ENROLLMENT FORM (pdf file)
    digital.ahrq.gov/sites/default/files/docs/resource/C3_Patient_Enrollment_Form_Blue.pdf
    June 16, 2021 - Telewound Care Network PATIENT ENROLLMENT FORM Telewound Care Network AHRQ/ NIH/ NLM Telewound Care … Network PATIENT ENROLLMENT FORM PATIENT NAME: _________________ ________ _____________________ … Videophone # _____________________________________________ Telewound Care Network PATIENT ENROLLMENT FORM

48. EvidenceNOW: Data Submission Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/evidencenow/projects/heart-health/research-results/research/submission-form-mw.html
    March 01, 2021 - EvidenceNOW: Data Submission Form Midwest Cooperative Resource: Chart Review: Submission for … Baseline, 12, & 18 Months (PDF, 148 KB, 2 pages) This data submission form was used by an EvidenceNOW

49. EvidenceNOW: Data Submission Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/evidencenow/projects/heart-health/research-results/research/submission-form-nw.html
    March 01, 2021 - EvidenceNOW: Data Submission Form Northwest Cooperative Resource: Blood Pressure Chart Abstraction … Protocol and Timeline (PDF, 118.25 KB, 2 pages) This data submission form was used by an EvidenceNOW

50. EvidenceNOW: Implementation Tracking Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/evidencenow/projects/heart-health/research-results/research/implementation-tracking-sw.html
    March 01, 2021 - EvidenceNOW: Implementation Tracking Form Southwest Cooperative Resource: Implementation … Tracking Note—Southwest Cooperative (PDF, 363.33 KB, 2 pages) This intervention tracking form used

51. Focus Group Consent Form (Spanish) | Digital Healthcare Research
    digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/focus-group-consent-form
    January 01, 2023 - Focus Group Consent Form (Spanish) Description Example consent form used in an … The form is in Spanish. … CHF) Technology Clinical Decision Support System PDF Focus Group Consent Form

52. Public Inquiry Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/contact/support.html
    send feedback about Agency for Healthcare Research and Quality (AHRQ) programs and activities via the form … Be aware that feedback from multiple AHRQ websites is received through this form, so please be as specific

53. Medication reconciliation: comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2). | PSNet
    psnet.ahrq.gov/issue/medication-reconciliation-comparing-customized-medication-history-form-standard-medication
    September 23, 2020 - Study Medication reconciliation: comparing a customized medication history form to … a standard medication form in a specialty clinic (CAMPII 2). … Medication reconciliation: comparing a customized medication history form to a standard medication form … Medication reconciliation: comparing a customized medication history form to a standard medication form … December 5, 2012 How reliable are patient-completed medication reconciliation forms compared

54. Medication reconciliation: comparing a customized medication history form to a standard medication form in a specialty clinic (CAMPII 2). | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/computer-assisted-medication-and-patient-information-interface-campii/citation/medication-reconciliation
    January 01, 2023 - Medication reconciliation: comparing a customized medication history form to a standard medication form … Medication reconciliation: comparing a customized medication history form to a standard medication form

55. Appendix. Audio/Video Concept Proposal Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/publications/pubcomguide/av-form.html
    March 01, 2025 - Audio/Video Concept Proposal Form Previous Page   Table of Contents Publishing and … Release Forms Appendix 1-B. Trademarks Appendix 1-C. … Completed Audio/Video Concept Proposal Forms should be submitted to MultimediaSupport@ahrq.hhs.gov . … Note to Grantees: While AHRQ grantees are not required to complete and submit this form, they may use … Audio/Video Concept Proposal Form (PDF, 666 MB)

56. 6.a-2 Feedback Form for Stool Test Negative | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool6a2.html
    April 01, 2018 - Tracking and Improving Screening for Colorectal Cancer Intervention 6.a-2 Feedback Form for Stool Test … Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE

57. Forms and Electronic Applications | Agency for Healthcare Research and Quality
    www.ahrq.gov/funding/process/app-forms/index.html
    November 01, 2015 - Forms and Electronic Applications Grant Application Forms Sign up: Grants Review Process … change from paper to electronic filing, the current PHS 398 application will be replaced by the Standard Form … For additional information on electronic grant applications, please go to Forms and Electronic Applications … Following this advice will ensure you have the latest forms and correct application package. … Research Grants Form/Application Instructions Description/Comments SF424 (R&R) (Word

58. 6.a-1 Feedback Form for Stool Test Positive | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool6a1.html
    April 01, 2018 - Tracking and Improving Screening for Colorectal Cancer Intervention 6.a-1 Feedback Form for Stool Test … Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE

59. Inter-Facility Infection Control Transfer Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/nursing-home/resources/inter-facility-infection.html
    April 01, 2022 - Inter-Facility Infection Control Transfer Form Resource: Inter-Facility Infection Control Transfer … Form ​This example inter-facility infection control patient transfer form can assist in fostering

60. 5.d-1 Chart Audit Review Form | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool5d1.html
    April 01, 2018 - Tracking and Improving Screening for Colorectal Cancer Intervention 5.d-1 Chart Audit Review Form … Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE